肺泡灌洗液GM试验对侵袭性肺真菌病的临床诊断价值  

Analysis of the Value of GM Test of Alveolar Lavage Fluid in the Diagnosis of Invasive Pulmonary Mycosis

作　　者：陈金花[1] 李薇薇 杨国溜[1] 郑佳莹[1] CHEN Jin-hua;LI Wei-wei;YANG Guo-liu;ZHENG Jia-ying(Fujian Provincial Hospital,Fujian Fuzhou 350001;School of Medical Technology and Engineering Fujian Medical University,Fujian Fuzhou 350001)

机构地区：[1]福建省立医院,福建福州350001 [2]福建医科大学医学技术与工程学院,福建福州350001

出　　处：《深圳中西医结合杂志》2021年第17期91-93,共3页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的:探究肺泡灌洗液半乳甘露聚糖(GM)试验对侵袭性肺真菌病(IPA)的临床诊断价值。方法:选择2017年3月至2019年2月福建省立医院收治164例高危感染IPA患者,参考美国抗感染学会制定的曲霉病和念珠菌病临床实践指南,将其分为确诊组(11例)、临床诊断组(98例)、拟诊组(55例),另选同期67例非IPA的肺部疾病患者设为非IPA组。应用酶联免疫吸附试验(ELISA)检测并计算患者肺泡灌洗液、血清GM指数。同时绘制受试者操作特征曲线(ROC),以GM试验中GM值大于拟定GM临界值为诊断阳性,分析肺泡灌洗液与血清GM指数诊断IPA的临床效能。结果:确诊组、临床诊断组患者的肺泡灌洗液、血清GM指数均显著高于拟诊组、非IPA组,且确诊组肺泡灌洗液、血清GM指数明显高于临床诊断组,组间比较,差异均具有统计学意义(P<0.05)。ROC曲线分析显示,当肺泡灌洗液GM指数的诊断阈值≥0.37时,诊断IPA的灵敏度为87.50%,特异度为81.20%。结果:肺泡灌洗液GM试验具有检测快速、灵敏度高等优点,辅助诊断IPA具有较高的临床价值。Objective To explore the clinical diagnostic value of galactomannan(GM)test of alveolar lavage fluid for invasive pulmonary mycosis(IPA).Methods From March 2017 to February 2019,149 patients with high-risk IPA were admitted to Fujian Provincial Hospital.According to the clinical practice guidelines for aspergillosis and candidiasis developed by the American Anti-Infective Society,they were divided into confirmed groups(11 cases),clinical diagnosis group(98 cases),proposed diagnosis group(55 cases),another 67 patients with non-IPA lung disease in the same period were selected as the non-IPA group.The enzyme-linked immunosorbent test(ELISA)was used to detect and calculate the GM index of the patient’s alveolar lavage fluid and serum.At the same time,the receiver operating characteristic curve(ROC)was drawn,the GM value in the GM test was greater than the proposed GM cut-off value to diagnose positive,and the clinical efficacy of the alveolar lavage fluid and serum GM index in the diagnosis of IPA was analyzed.Results The alveolar lavage fluid and serum GM index of patients in the diagnosed group and the clinical diagnosis group were significantly higher than those of the proposed group and the non-IPA group,and the alveolar lavage fluid and serum GM index of the confirmed group were significantly higher than those of the clinical diagnosis group.In comparison,the differences were statistically significant(P<0.05).ROC curve analysis showed that when the diagnostic threshold of alveolar lavage fluid GM index was≥0.37,the sensitivity of diagnosing IPA was 87.50%and the specificity was 81.20%.Conclusion The GM test of alveolar lavage fluid has the advantages of rapid detection and high sensitivity,and it has high clinical value in assisting the diagnosis of IPA.

关 键 词：侵袭性肺真菌病 肺泡灌洗液 半乳甘露聚糖试验 

分 类 号：R519[医药卫生—内科学]